Wastewater antibody signatures reflect SARS-CoV-2 infection and immunization patterns in the population

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Wastewater antibody signatures reflect SARS-CoV-2 infection and immunization patterns in the population

Journal Article (2026)

Author(s)

Dhammika Leshan Wannigama (Yamagata Prefectural University of Health Sciences, University of Sheffield, Chulalongkorn University, Yamagata University, Yamagata Prefectural Central Hospital)

Mohan Amarasiri (Yamagata Prefectural Central Hospital, Tohoku University)

Phatthranit Phattharapornjaroen (Yamagata Prefectural Central Hospital, Chulabhorn Royal Academy)

Cameron Hurst (Thammasat University, University of Queensland, Yamagata Prefectural Central Hospital)

Charin Modchang (Ministry of Higher Education, Science, Research and Innovation, Mahidol University)

John Giles (Gates Foundation)

Jillian Gauld (Gates Foundation)

Tanakorn Chantanasaro (Mahidol University)

Kazuhiko Miyanaga (Jichi Medical University)

Longzhu Cui (Jichi Medical University)

Stefan Fernandez (Armed Forces Research Institute of Medical Sciences, Thailand)

Hirotake Mori (Juntendo University)

Puey Ounjai (Mahidol University)

Sudarat Chadsuthi (Naresuan University)

Ali Hosseini Rad S. M (Kite Pharma Inc)

Rosalyn Kupwiwat (Yamagata Prefectural Central Hospital)

Chaisit Kupwiwat (Vibhavadi Hospital)

Porames Vatanaprasan (Yamagata Prefectural Central Hospital)

Dylan John Jay (Yamagata Prefectural Central Hospital)

Yoshitaka Shimotai (Yamagata University)

Chayanin Sararat (Mahidol Oxford Tropical Medicine Research Unit)

Sirirat Luk-in (Mahidol University)

Phitsanuruk Kanthawee (Mae Fah Luang University)

Mahesh Dharne (CSIR-National Chemical Laboratory (CSIR-NCL))

Ratana Tacharoenmuang (National Institute of Health)

Suparinthon Anupong (Naresuan University)

Nada M. Melhem (American University of Beirut)

Takashi Furukawa (Kitasato University)

Yangzhong Wang (Affiliated Fuling hospital of Chongqing University)

Andrew C. Singer (Centre for Ecology and Hydrology)

Naveen Kumar Devanga Ragupathi (Bioberrys Healthcare and Research Centre, University of Sheffield)

Jinxin Zhao (Monash University)

Kazunari Sei (Kitasato University)

Asuka Nanbo (Nagasaki University)

Asada Leelahavanichkul (Chulalongkorn University)

Talerngsak Kanjanabuch (Chulalongkorn University, King Chulalongkorn Memorial Hospital)

Paul G. Higgins (University Hospital Cologne, Partner Site Bonn-Cologne)

Daisuke Sano (Tohoku University)

Anthony Kicic (Perth Children's Hospital, Curtin University, Telethon Kids Institute, The University of Western Australia)

Gertjan Medema (TU Delft - Civil Engineering & Geosciences, KWR Water Research Institute)

Tetsuji Aoyagi (Tohoku University)

Sam Trowsdale (The University of Auckland)

Parichart Hongsing (Catholic University of Madagascar, Yamagata Prefectural Central Hospital, Women and Marginalized Health Research Alliance)

Xiaonan Yang (Yamagata Prefectural Central Hospital, Fuyang Women and Children's Hospital, Pathogen Hunter's Research Collaborative Team)

Aisha Khatib (University of Toronto Faculty of Medicine)

Kenji Shibuya (Tokyo Foundation for Policy Research)

Shuichi Abe (Yamagata Prefectural Central Hospital, Yamagata University)

Hiroshi Hamamoto (Yamagata University)

Research Group

Water Systems Engineering

COVID-19 SARS-CoV-2 Wastewater-based epidemiology Antibodies Vaccination Population immunity Public health surveillance Serosurveillance

DOI related publication

https://doi.org/10.1016/j.watres.2026.126539 Final published version

To reference this document use

https://resolver.tudelft.nl/uuid:92c1a9f4-0879-4977-b5c6-a9c1ac76ce51

More Info

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Publication Year

2026

Language

English

Research Group

Water Systems Engineering

Journal title

Water Research

Volume number

306

Article number

126539

Downloads counter

28

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Abstract

Wastewater-based epidemiology (WBE) has been widely used to track SARS-CoV-2 transmission using viral RNA, but its capacity to capture population immunity remains poorly defined. Although antibodies can be recovered from wastewater, the relationship between wastewater antibody signals, individual-level shedding dynamics, and community-wide infection and immunity patterns has not been systematically established. We conducted a three-year longitudinal study (2020–2022) across urban and rural communities in Thailand, covering approximately 18 million people. SARS-CoV-2 viral RNA and anti-SARS-CoV-2 IgG concentrations were quantified in wastewater from diverse facility types. To calibrate wastewater signals, faecal viral RNA and IgG shedding kinetics were characterised in 412 individuals from the same communities. Deconvolution models were applied to infer infection incidence from wastewater measurements, and lagged regression analyses assessed associations with confirmed cases, mortality, and vaccination coverage. Faecal viral RNA shedding peaked early after symptom onset and declined rapidly, whereas anti-SARS-CoV-2 IgG exhibited delayed onset, peaked around 50 days, and persisted for several months. These distinct kinetics produced temporally offset wastewater signals, with RNA-based incidence consistently preceding antibody-based estimates. Prior to vaccine rollout, wastewater incidence was dominated by viral RNA signals, while antibody levels remained low. Following widespread vaccination and successive infection waves, antibody-based incidence increased and gradually converged with RNA-based estimates, particularly in highly vaccinated urban areas. Wastewater antibody levels showed strong temporal autocorrelation and positive lagged associations with confirmed cases and vaccination, with weaker associations with mortality. Integrating viral RNA and antibody measurements in wastewater, informed by individual-level shedding dynamics, enables concurrent assessment of infection burden and population immunity.

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